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Board Certifications: American Board of Facial Plastic and
Reconstructive Surgery American Board of Otolaryngology - ABO

Revision Rhinoplasty in NYC

Revision rhinoplasty is a procedure done to correct aesthetic or functional issues as well as deformities following primary or secondary nose surgery. During a revision nose job in New York, Dr. Rizk's main goal is to provide patients with the results they expected the first time around. When patients research a revision rhinoplasty surgeon, they are naturally more wary because of their previous bad experience with the procedure.

Dr. Rizk understands this and is committed to providing patients with all of the information required to make an educated, confident decision. He is a highly trained and experienced specialist in not only sculpting the natural appearance of the nose but also in ensuring its optimal function.

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Before and After Revision Rhinoplasty *Results may vary. View More Photos
Female patient Before and After Revision Rhinoplasty *Results may vary. View More Photos

Why Is Revision Rhinoplasty Surgery Complicated?

In a secondary nose job, the tissue inside the nose has undergone changes and may not tolerate extensive dissection, thinning procedures, or multiple incisions. Some noses have very thin skin and extensive scar tissue inside. The skin in revision surgery is not as pliable, which means that it does not easily tolerate expansion or contraction.

Therefore, the surgeon must use specialized techniques to effect a change in the structure of the nose to overcome the scar tissue. To create a greater tension than the scar tissue and skin envelope, Dr. Rizk uses suture and cartilage graft techniques. This translates into greater resistance and change in the structure of the nose.

FOX National News Features Revision Rhinoplasty Expert Dr. Sam Rizk

FOX National News Features Revision Rhinoplasty Expert Dr. Sam Rizk
*Results May Vary

Types of Deformities Addressed in Revision Rhinoplasty

Below are explanations of some of the most common deformities addressed in revision procedures.

Inverted V Deformity

  • What is it? This type of nasal deformity is characterized by an inverted V-shaped shadow in the area of the middle vault of the nose.
  • How it occurs: Overresection of the upper lateral cartilage, the cartilage that forms the sides of the nose’s bridge. It often occurs when the surgeon who performed the original procedure made a mistake during the removal of a nasal bump and during the fracturing of the nasal bones (this destabilizes the upper lateral cartilage).
  • How to correct it: Dr. Rizk prefers surgery to fillers because fillers do not fix the deformity permanently. The volume gained through hyaluronic acid-based fillers, for instance, lasts for about six months. Fillers are also less precise than surgery and can make the nose look larger. Moreover, they can cause inflammation and scar tissue, which makes a later surgery more difficult to perform. Finally, fillers can move around inside the nose. Therefore, he favors surgery to fillers when correcting an inverted V deformity. The surgery often involves the placement of dorsal cartilage above the nasal bridge to narrow the nose and widen the middle nasal vault.
Female Revision Rhinoplasty Diary

Female Revision Rhinoplasty Diary
*Results May Vary

Hanging Columella

  • What is it? The columella is the strip of skin between the nostrils. A hanging columella, or “alar-columellar disproportion,” is one that is visible from the profile and hangs lower than desired, typically about 4mm or more.
  • How it occurs: There are many potential causes of hanging columellae. Some people are born with it, in which case it is often the result of either a long septum and/or the columella cartilages pushing down on the columella. Other people end up with deformity due to a mistake made during their primary procedure.
  • How to correct it: This depends on the cause of the deformity. Excess tissue may be removed after making an incision, and a portion of the septum may be removed. Other cartilage may be removed or shaved. In rare cases, the nasal spine may be reduced.

Saddle Nose Deformity

  • What is it? A saddle-like formation in the area of the septum. This type of deformity is sometimes referred to as a “scooped nose.”
  • How it occurs: Typically, some type of trauma to the nose, like a blow to the face, causes the septum to lower.
  • How to correct it: The septum can be raised or a cartilage graft can be added to the depression, to fill it in.

External Nasal Valve Collapse

  • What is it? External nasal valve collapse is caused by weakness or narrowness in the nasal valve, the thinnest portion of the nasal airway.
  • How it occurs: Trauma to the nose or mistakes made during the original procedure.
  • How to correct it: In some cases, it is possible to treat by lifting the cheek tissue on the side of the nose that is blocked. In other cases, surgery may be needed. There are several different surgical approaches that may be employed. For example, alar batten grafts may be grafted as appropriate if the collapse was caused by weakness in the nasal sidewall. The surgeon performing the revision procedure will need to assess the cause prior to choosing which approach to adopt.

Pinched Tip

  • What is it? A nasal tip that appears too narrow, or “pinched.”
  • How it occurs: Some patients are born with a pinched tip, but this type of deformity is often the result of over-resection of the tip cartilages during the original procedure.
  • How to correct it: Usually, a “tip-plasty” is performed to reshape the tip with ear or other cartilage.

Pointy Nasal Tip

  • What is it? A nasal tip that appears pointy essentially means that the alar cartilages are too prominent and appear too pointy, or stick out too much.
  • How it occurs: Many patients are born with pointy nasal tips. This deformity is more common in individuals with thin skin.
  • How to correct it: It depends on the patient’s unique anatomy. The endonasal (internal incisions) approach is used on some patients, while an open approach is used on others. The cartilage may be shaved or trimmed. In thin-skinned patients, a soft tissue graft or fascia may be placed over the tip cartilage. Repairing a pointy nasal tip, or another deformity of the tip, is one of the most challenging of all rhinoplasty procedures.

Open Roof Deformity

  • What is it? A space is formed when the nasal bones do not come together near the top of the nose. An open roof deformity makes the nose appear excessively wide. Typically, the nasal skin grows or droops, and vertical lines or depressions start to appear.
  • How to correct it: It depends on how low or high the nasal bones are positioned. Osteotomies (fractures) may be necessary, and on-lay grafts may be used to close the gap between the nasal bones.

Cleft Lip Nose Deformity

Cleft lip nose deformity is a common birth defect that can severely impact a person’s appearance. In the United States, nearly all cleft lip nose deformities are corrected in infanthood, as failure to correct this deformity can result in developmental impairment, infection, and even death. Cleft lip nose patients commonly require additional surgery later in life to fully correct the deformity.

Cleft lip nose occurs when the upper lip does not form completely in utero, leaving a separation or "cleft" in the lip.

About half of all children born with a cleft lip will also suffer from a cleft palate, which is a separation on the roof of the mouth and the most serious manifestation of the disorder. Cleft lip causes the lip and nose to develop asymmetrically, resulting in obvious deformities that can cause feeding issues, breathing difficulty, and speech problems, all of which contribute to developmental delays in the child. As such, early surgical intervention is almost always recommended.

Most often, the surgery will be performed to correct obvious asymmetries in the upper lip and nose. The surgery must be performed by a doctor who has received specific training in correcting cleft lip nose deformity.

Dr. Rizk Featured on Tatler's Beauty

Dr. Rizk Featured on Tatler's Beauty & Cosmetic Surgery Guide

Dr. Rizk Featured on About.com - Luxury Travel Meets Medical Tourism

Dr. Rizk Featured on About.com - Luxury Travel Meets Medical Tourism

Dr. Sam Rizk, a New York facial plastic surgeon specializing in surgery of the face and neck, is highly experienced in correcting deformities associated with the cleft lip nose defect.

Cheiloplasty, the surgery performed to correct cleft lip nose, typically produces positive results and allows the child to enjoy a normal childhood after surgery. In most cases, the child will not remember the surgery or the difficulties they experienced as a result of the condition.

Revision Rhinoplasty Cost

Revision rhinoplasty tends to be more expensive than a primary procedure due to the experience and skill required to successfully perform this difficult procedure.

When you underwent your primary nose job, you should have been given a breakdown of three main fees that determine the price of your nose job. These same fees must be established to determine the price of a secondary nose job.

The total cost for a revision nose job includes:

  • The surgeon’s fee, which will be calculated based upon the type of nose surgery being performed and the revisions required. Typically senior surgeons who have more specialized experience will charge a higher fee than more junior surgeons.
  • The anesthesia fee, which encompasses the fee for the anesthetist and the medications that will be used.
  • The operating facility fee that is charged by the surgical center. This fee may vary based upon the length of your surgery and whether an overnight stay is required.

Added together, these three fees will define the cost of your secondary nose surgery, which will be a unique amount based upon the details of your specific procedure. You should also consider the costs that will not be included in the secondary fee. For example, painkillers, antibiotics, ice packs, and bandages may need to be purchased to aid your recovery.

Patients frequently ask us if their health insurance will cover the cost of a revision nose job. We give patients the same advice for both primary and revision rhinoplasty – health insurance may cover procedures that are performed to correct or improve nasal function (for example, to straighten a deviated septum and improve the patient’s ability to breathe through the nose).

Understanding The Recovery Period

As revision rhinoplasty candidates have already undergone the surgery at least once, they have a good idea of what the recovery period entails. Typically, revision rhinoplasty with Dr. Rizk in NYC is less painful than a primary nose job.

As a result, patients often experience very little pain during their recovery period. Once the procedure is complete, patients are given pain medications to help them manage any discomfort. Moreover, he prescribes antibiotics to his patients to prevent them from developing an infection following their operation.

The amount of bruising and swelling that a patient experiences following a revision surgery depend on the extent of the revisions being performed. Normally, patients will have less bruising and swelling than they did during their first surgery.

Revision patients in NYC should allow for approximately one week before they look presentable and are able to return to their daily routine, including work. If you experience only slight swelling and bruising following the procedure, you may also feel comfortable doing light activities such as walking.

Generally, patients can resume all of their normal activities within one month of their surgical operation. As with any form of rhinoplasty, it is important to understand that the full results of a nose job should only be judged one year after the surgery. This is because the nose will continue to change as it settles into its new position and all swelling subsides.

Minimizing the Risk of Revision Rhinoplasty Complications

There are a number of things you can do to minimize your risk of experiencing complications following your revision procedure.

Experience of Female Revision Rhinoplasty Patient of Dr. Rizk

Experience of Female Revision Rhinoplasty Patient of Dr. Rizk
*Results May Vary

Choose the Right Surgeon

Choose an experienced, board-certified facial plastic surgeon who specializes in nose jobs and revision procedures. General plastic surgeons are well trained but do not have the same expertise in facial plastic procedures.

Prepare for Your Surgery

Before heading to your consultation, gather all of your medications, over-the-counter products, and any supplements you take so that you can show them to your doctor (in case any of them might cause problems with your surgery). If you are a smoker, then stop smoking well in advance of your surgery.

Make sure to follow your surgeon’s post-operative instructions and arrange for someone to help you with your aftercare. All revision nose job patients need some assistance during the postoperative period.

Things to Avoid

There are a number of things you should avoid if you will be undergoing revision surgery - your surgeon will discuss this with you. Definitely avoid having your surgery overseas. While it might save you money in the short term, it might cost you more if something goes wrong.

Understanding the Psychology Behind Revision Rhinoplasty

It is important to understand the psychology of secondary rhinoplasty patients who have been disappointed with their previous procedures and have less tolerance for postoperative problems. Patients also may feel guilty that they did not provide enough information to the surgeon, did not ask enough questions, did not do enough research into the surgeon's qualifications, or did not communicate their desires correctly to the surgeon.

This guilt may increase the patient's anxiety about the secondary rhinoplasty procedure.

In addition, in revision surgery, it is necessary to assess patient motivation. Dr. Rizk points out that there are many types of patients who consider the procedure. The continuum ranges from patients with poor results that seek improvement but like their previous surgeons, to patients with objectively good results but who are desperately unhappy and furious with their first plastic surgeon.

Preoperative photography and thorough interviews with the revision patient are imperative. It is also important to distinguish patient anger toward their previous surgeon from disappointment with an outcome the patient didn’t expect.

Most surgeons’ intentions are to do their best to help their patients. Dr. Rizk reminds patients of this fact to try to diffuse their anger.

Dr. Rizk does not operate on angry patients and he attempts to convert an angry patient's attitude towards their previous surgeon from that of resentment to one of disappointment. Patients must understand the margin of error inherent in human surgery and healing. All patients must understand that perfection is unattainable and any patient seeking perfect results is not considered a good candidate by him. Additionally, patients with body dysmorphic disorder who continually seek cosmetic surgery are not good candidates for revision nose surgery in NYC.

Am I a Candidate for Revision Rhinoplasty?

Not everyone is a suitable candidate, and not all deformities can be corrected. It depends more on what was done in the original surgery and on factors specific to your anatomy than on how many procedures you have had.

Important factors include:

  • The integrity of the skin
  • How much cartilage was removed in the original procedure
  • How much scar tissue there is
  • The extent of the deformity and whether you need grafting

It is important that you have realistic expectations.

Why Choose Dr. Rizk For Revision Rhinoplasty in NYC?

Dr. Rizk leverages decades of experience, a background in artistry, and his meticulous attention to detail to perform revision rhinoplasty procedures that are customized to each patient. His unique eye and understanding of anatomical structure allow him to address the “aesthetic units” with extreme precision and beautiful social presentation.

Dr. Rizk has been featured in national and international media. Please contact his office today if you are interested in having revision nose surgery in New York.

Sam Rizk, MD

By Dr. Sam S. Rizk, M.D., FACS.

Dr. Rizk is a double board-certified facial plastic surgeon who specializes in rhinoplasty surgery and a recognized expert on the latest advances in facial plastic surgery techniques. He performs a range of facial plastic surgeries at his New York practice.

Learn more about Dr. Rizk | Dr. Rizk's Google Scholar

Last Modified On: 2/8/2022

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